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Everything is good in Sudan

Š 2011 by Marcell Nimfuehr. The book author retains sole copyright to his contributions to this book.

Tamam ` ´ Medecins Sans Frontieres hospital in Agok, South Kordofan, Sudan

By 9 July 2011 South Sudan will have become the newest nation. A civil war of 40 years with North Sudan, a secession, a peace agreement, continuous fighting and a referendum have preceded independence. There is one region between North and South Sudan that is contested. Officially the region of Abyei belongs to the North but is held by the Southern Army. In 2009, massive fighting has caused 50.000 people to leave Abyei city to seek refuge in the South, many of them settling in the village of Agok. Médecins Sans Frontières (MSF) has supported those displaced two years ago with emergency care. The areas‘ situation is still unresolved. Clashes continue. Life goes on. MSFs’ emergency intervention in Agok has turned into a full hospital, covering maternity, malnutrition, diseases such as Malaria and even emergency surgery in the only operation theatre available to 100.000 people.

Outpatient clinic At the other end of Agok town, MSF runs an outpatient clinic, treating children under the age of 15. The clinic sees patients that are not ill enough to be sent to the hospital. On a busy day there will be hundreds of children screened for malnutrition and diseases. The MSF outpatient clinic in Agok, South Kordofan, Sudan.

Mothers wait in line with their children to have them screened. In April, the clinic treats about 250 children with malnutrition. But this is still the good season. In May starts the hunger gap, the time between the last food has been consumed and the next harvest is still months away. One way of diagnosing malnutrition is the MUAC-bracelet. The circumference of a childs upper arm is a good indicator for its nutrition status. A circumference lower than 135mm signifies the need for treatment. This threshold counts for all children between six months and five years. Malnourished children need more than bare calories. They need vitamins, nutritients and minerals. This is delivered by a therapeutic food called Plumpy Nut. It‘s made of peanuts, milk, sugar and added minerals. It tastes like peanut butter and the kids seem to love it.

Vaccination campaign Populations on the move risk epidemics and diseases. MSF does ongoing vaccination campaigns. About 1000 people have left Abyei following clashes in March 2011. They have settled in a village called Mading Acueng, 20 kilometres south. MSF has vaccinated over 250 children in one day. It‘s quite a coctail on the vaccination list: Polio, Diphteria, Tetanus, Measles and Tuberculosis. Being there you experience a cacophonia of dozens of children crying, shouting and fighting.

Kids are again also screened for malnutrition. MSF treats only those in the greatest needs, those up to five years. To find out if a child is older the team asks the kid to scratch one ear with the other side‘s hand. Children under six can‘t do that.

A drop can save lives, the polio vaccination. The day in Mading Acueng also shows that the displaced people are in good shape, there are no big humanitarian needs. MSF is ready to support them with non-food-items but it doesn‘t appear to be necessary. At last, children receive a tablet with Vitamin A to prevent malnutrition and measles and with Albendazole to treat intestinal worms. Then they receive a bar of nicely colored soap as an incentive. By the end of the day, there are 250 kids running around with pink soap.

The hospital Just a few tents in 2009, by now MSF has built a complete hospital in Agok. It has an inpatient department, a therapeutic feeding centre for malnourished children, an operation theatre, a lab and isolation wards for tb patients. The 70 bedhospital is so busy that the needs often exceed its capacity. On a very busy day in late March 2011, the maternity team delivered five children in a single day.

US-American physician Xandra checks-up on a child with Malaria. This child will survive. Others are less lucky. For a whole day Xandra tried to resuscitate a three month old Meningitis patient. But without success. The little boy died in the following night. His name was Dau.

Kenyan midwife Pamela (far back) does rounds with her South Sudanese staff. Capacity building is of great need. There are just no nurses and doctors in South Sudan. MSF does a lot of teaching. For every expatriate there are ten national staff. National staff nurse screening patients. The success of the hospital is visible. While 75 percent of all South Sudanese have no access to medical care and one in seven women die in labor, the death rate in the hospital is below two percent. And that is mostly atrributed to the very late arrival of patients.

Operation Theatre As tensions were rising during the referendum period, MSF has built an operation theatre to be able to apply surgery to potential wounded patients. When the situation is calm, MSF performs mostly emergency Cesarean sections and other emergency operations. Here, the team around medical team leader Ines from Germany and surgeon Laurence from Kenya perform an operation on an acute abdomen relieving inflated intestines. Without the surgery, the woman would have gone into sepsis and most likely have died within a week. Medical team leader Ines wakes the patient after a successful operation. She is aided by a translater who passes the wake-up calls in native language Dinka. Patient consent form, signed with a fingerprint.

The patients in Agok In Agok, most people live in simple straw-roof huts. They have no electricity and no running water. Due to the tensions there is little food to be found in the local market. Since they usually have no means for transport, it is a gamble if people in need reach the hospital in time.

Expats compound There are 14 expatriates in Agok. They come from Australia, Austria, Germany, France, Italy, Kenya, Switzerland, USA. They live and work here for four to six months. Heat, dust, despair, food shortage, clashes nearby: in order to still be able to do the strenous work, the expatriate cherish their little common private compound.

The best team ever

US-American midwife Leslie taking care of the compound-kittens. Italian construction logistican Guiseppe, building palaces from sand and obviously being the best cook in town. Swiss head logistician Vincent while refuelling the MSFplane that brings in materials. His greatest achievment was to open the hospitals bore hole to the community, bringing them clean water. Kenian deputy medical coordinator Dekow, making things work. Australian nurse Lisa. She is the angel of the outpatient clinic and the much feared master of vaccination campaigns. Medical team leader Ines from Germany. She is the one that goes the longest working hours. Austrian logistician Ralf while mending his pants. In his spare time he has built an aircondition system out of a fan, some cloth and a water drip. Swiss administrator Joanne and logistician Vincent on a Sunday evening. In August the two are going to get married.


Everything is good in Sudan